The feasibility of automating audit and feedback for ART guideline adherence in Malawi

Zach Landis Lewis; Claudia Mello-Thoms; Oliver J Gadabu; E Miranda Gillespie; Gerald P Douglas; Rebecca S Crowley

doi:10.1136/amiajnl-2011-000097

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The feasibility of automating audit and feedback for ART guideline adherence in Malawi

Zach Landis Lewis, Claudia Mello-Thoms, Oliver J Gadabu, E Miranda Gillespie, Gerald P Douglas and Rebecca S Crowley

Journal of the American Medical Informatics Association : JAMIA, Vol.18(6), pp.868-874

11/2011

DOI: 10.1136/amiajnl-2011-000097

PMCID: PMC3197989

PMID: 21565857

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Abstract

To determine the feasibility of using electronic medical record (EMR) data to provide audit and feedback of antiretroviral therapy (ART) clinical guideline adherence to healthcare workers (HCWs) in Malawi. We evaluated recommendations from Malawi's ART guidelines using GuideLine Implementability Appraisal criteria. Recommendations that passed selected criteria were converted into ratio-based performance measures. We queried representative EMR data to determine the feasibility of generating feedback for each performance measure, summed clinical encounters representing each performance measure's denominator, and then measured the distribution of encounter frequency for individual HCWs across nurse and clinical officer groups. We analyzed 423,831 encounters in the EMR data and generated automated feedback for 21 recommendations (12%) from Malawi's ART guidelines. We identified 11 nurse recommendations and eight clinical officer recommendations. Individual nurses and clinical officers had an average of 45 and 59 encounters per month, per recommendation, respectively. Another 37 recommendations (21%) would support audit and feedback if additional routine EMR data are captured and temporal constraints are modeled. It appears feasible to implement automated guideline adherence feedback that could potentially improve HCW performance and supervision. Feedback reports may support workplace learning by increasing HCWs' opportunities to reflect on their performance. A moderate number of recommendations from Malawi's ART guidelines can be used to generate automated guideline adherence feedback using existing EMR data. Further study is needed to determine the receptivity of HCWs to peer comparison feedback and barriers to implementation of automated audit and feedback in low-resource settings.

Anti-Retroviral Agents - therapeutic use

Guideline Adherence

Feedback

Malawi

Health Personnel

Humans

Medical Audit - methods

Electronic Health Records

Automatic Data Processing

Feasibility Studies

Practice Guidelines as Topic

Details

Title: Subtitle: The feasibility of automating audit and feedback for ART guideline adherence in Malawi
Creators: Zach Landis Lewis - Department of Biomedical Informatics, Center for Health Informatics for Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA. zjl1@pitt.edu
Claudia Mello-Thoms
Oliver J Gadabu
E Miranda Gillespie
Gerald P Douglas
Rebecca S Crowley
Resource Type: Journal article
Publication Details: Journal of the American Medical Informatics Association : JAMIA, Vol.18(6), pp.868-874
DOI: 10.1136/amiajnl-2011-000097
PMID: 21565857
PMCID: PMC3197989
NLM abbreviation: J Am Med Inform Assoc
ISSN: 1067-5027
eISSN: 1527-974X
Publisher: England
Grant note: T15 LM007059 / NLM NIH HHS UL1 TR000005 / NCATS NIH HHS 5T15LM007059-24 / NLM NIH HHS
Language: English
Date published: 11/2011
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology
Record Identifier: 9984051784302771

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